Childhood diabetes in Argentina and Norway : A comparative study of guideline

Abstract Aims: To compare and illustrate the treatment of diabetes in Norway and Argentina using the International Society for Pediatric and Adolescent Diabetes (ISPAD) and American Diabetes Association (ADA) guidelines. Methods: Part one: Literature review of diabetes using the ISPAD and ADA guidelines and non-systematic search on Pubmed. Part two and three: Literature review of information about Argentina and Norway. Comparison of Drammen and Buenos Aires (BA) based up on a semi structural questionnaire used to interview health personnel at two public hospitals in BA (Hospital de Niños and Hospital Narciso (N.) Lopez) and one public hospital in Drammen (Buskerud Central Hospital). Results and discussion: In 2011 all three hospitals used the ISPAD guidelines as a basis for diagnosis and treatment of children with diabetes. The reported treatment results, patients reaching HbA1c < 7.5 %, were better in BA compared to Drammen (65 % at Hospital de Niños and 60 % at Hospital N. Lopez compared to 23 % at Buskerud Central Hospital). In Drammen 80 % of the children used insulin pump while this is not offered to the children at public hospitals in BA due to financial causes. In BA the majority of the children use MDI. The children in BA get a limited number of blood glucose (BG) strips for free (enough to measure three times a day) and have to buy the rest themselves. In Norway the children get unlimited numbers of BG strips for free. All three hospitals provide education, regular checkups and screening for complications as recommended by the ISPAD and ADA guidelines. The children in Drammen are admitted to the pediatric ward together with both their parents the first two weeks after diabetes onset. In BA the children get education at the out patients clinic at diabetes onset. Unlike Drammen, both hospitals in BA report long term complications among children/ adolescents < 15 years of age. The numbers we got in BA concerning treatment results as-well as acute- and long term complications where all based on clinical experience, while numbers from Norway are from the Norwegian Childhood Diabetes Registry where all children/adolescents with diabetes in Norway are registered. Conclusion: All three hospitals use the ISPAD guidelines as basis for their treatment of children/adolescents with diabetes. Both the economic systems and health care systems are very different in Argentina and Norway. Even a higher proportion of the patients in BA reached treatment goal compared to Drammen, late diabetes complications were only seen in BA. Generally registration is a good tool for monitoring a disease; both incidence, treatment and treatment results